mobey Posted August 7, 2012 Posted August 7, 2012 Well, just when I think I am getting good I get presented with this: I am sure many of you will have no problem, but it as my first one, so it took like 10min beore I knew wtf I was working with..... 81 y/o female. aprox 140lbs, sudden onset chest pain while sitting drinkng tea with husband. Pain = 10/10, crushing, radiating to lower back. Nausea 10/10.... dry heaving like crazy Pale-grey, diphoreic, good turgor. No distal edema, JVD present. Complains of SOB Pulse 112 BP 74/58 Bilateral. Sp02 98% Afebrile ECG = unremarkable. Sinus tach, narrow QRS, no T,ST changes History: Spondylitis (Kyphosis noted). 1
Kaisu Posted August 7, 2012 Posted August 7, 2012 My first guess is cardiogenic shock. Any cardiac history?
mobey Posted August 7, 2012 Author Posted August 7, 2012 My first guess is cardiogenic shock. Any cardiac history? Nope, no cardiac hx
scubanurse Posted August 7, 2012 Posted August 7, 2012 Did you do a 12 lead? Any improvement with position change? and palpable masses in the abdomen? Very odd indeed...
paramatt_ Posted August 7, 2012 Posted August 7, 2012 Maybe thoracic aneurysm/disection? Bilateral radials present? 1
fakingpatience Posted August 8, 2012 Posted August 8, 2012 With the + JVD and hypotension, I'm thinking cardiac tamponade, but I don't know if it could occur suddenly like that
Happiness Posted August 8, 2012 Posted August 8, 2012 I dont know much about the hunched back but would it not eventually put pressure on the heart and stomach which would have these symptoms present and also how has this pt been feeling days, weeks, and months befor this episode ? Did you listen in abdominal area the whishing sounds of a triple A. (I was lucky early in my career to hear that sound and you never forget it)
mobey Posted August 8, 2012 Author Posted August 8, 2012 Forgot a medication: MTX, and arthrotec. Sorry bout that.... Maybe thoracic aneurysm/disection? Bilateral radials present? Bilateral radials are present. Note I said BP was bilateral With the + JVD and hypotension, I'm thinking cardiac tamponade, but I don't know if it could occur suddenly like that OK.... so now what? Heart and lung sounds? Lung sounds were clear in apicies, couldn't hear much in the bases. Her Kyphosis is pretty severe, and chest wall movement is an issue. As far as heart sounds go: I'd love to say no gallop, good S1S2, but I'd be faking it. I have no idea what to listen for.... I thought her heart sounded quiet... or distant. Did you do a 12 lead? Any improvement with position change? and palpable masses in the abdomen? Very odd indeed... See original post for 12 lead. No, and no for the rest of your question. Here is an example of the degree of kyphosis http://www.sciencephoto.com/media/260141/enlarge
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